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Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel

Published online by Cambridge University Press:  24 April 2013

Alaa Al Amiry ,
Richard A. Bissell ,
Brian J. Maguire  and
Donald W. Alves
Alaa Al Amiry*
Affiliation:
Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan. Current affiliation: Ajman University of Science and Technology, Ajman, UAE
Richard A. Bissell
Affiliation:
University of Maryland, Baltimore County Department of Emergency Health Services, Baltimore, Maryland USA
Brian J. Maguire
Affiliation:
University of Maryland, Baltimore County Department of Emergency Health Services, Baltimore, Maryland USA. Current affiliation: School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Qld Australia
Donald W. Alves
Affiliation:
Department of Emergency Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
*
Correspondence: Alaa Al Amiry, MS, BSN, NRCCEMT-P, PNCCT Ajman University of Science and Technology P.O. Box 346 Ajman UAE E-mail alamiry_alaa@hotmail.com or a.alamiry@ajman.ac.ae
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Abstract

Introduction

The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel.

Hypothesis/ Problem

The hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population.

Methods

This was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the StudySize 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) ‘Δ’ = 4.53% can be detected at α = 5% and power = 80% with N = 110.

Results

Samples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population.

Conclusion

There is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.

Al AmiryA, BissellRA, MaguireBJ, AlvesDW. Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel. Prehosp Disaster Med. 2013;28(4):1-5.

Keywords

bioterrorismcontaminationEmergency Medical Serviceshand washinginfection controlMethicillin-resistant Staphylococcus aureus (MRSA)nasal colonizationprehospitalsurveillance
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 4 , August 2013 , pp. 348 - 352
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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References

1.Fluit, AC, Wielders, JV, Schmitz, FJ. Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY Study. J Clin Microbiol. 2001;39(10):3727-3732. www.jcm.asm.org. Accessed June 16, 2010.CrossRefGoogle Scholar
2. Centers for Disease Control and Prevention, US Department of Health and Human Services. MRSA in Healthcare Settings 2007. http://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html. Accessed April 12, 2010.Google Scholar
3.Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated Methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis. 2008;46(6):787-794.CrossRefGoogle ScholarPubMed
4.Muto, CA. Designing a program to eliminate MRSA transmission part I: Making the clinical case. Presented at APIC 2006. http://www.apic.org/Content/NavigationMenu/…/061206_muto.pdf. Accessed June 9, 2010.Google Scholar
5.Boggs, W. ‘Superbug’ may be common in ER workers: prevalence varies, but researchers stress universal hygiene practices. Reuters; December 29, 2008.Google Scholar
6.Elie-Turenne, MC, Fernandes, H, Mediavilla, JR, et al. Prevalence and characteristics of Staphylococcus aureus colonization among healthcare professionals in an urban teaching hospital. Infect Control Hosp Epidemiol. 2010;31:574-580.CrossRefGoogle Scholar
7.Gorwitz, RJ, Kruszon, MD, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the US, 2001-2004. J Infect Dis. 2008;197(9):1226-1234.CrossRefGoogle Scholar
8.Elliott, MJ, Kellum, MT, Tenover, FC, Pettriess, RL. Nasal carriage of Methicillin- susceptible and Methicillin-resistant Staphylococcus aureus among paramedics in the Sedgwick County emergency medical service in Wichita. Infect Control Hosp Epidemiol. 2002;32(2):60-61.CrossRefGoogle Scholar
9.Hidron, AI, Kourbatova, EV, Halvosa, JS, et al. Risk factors of colonization with Methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: Emerging of community-associated MRSA nasal carriage. Clin Infect Dis. 2005;41:159-166.CrossRefGoogle Scholar
10.Ellis, M, Griffith, M, Dooley, D, et al. Targeted intranasal Mupirocin to prevent colonization and infection by community-associated Methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother. 2007;51(10):3591-3598.CrossRefGoogle ScholarPubMed
11.Chang, S, Sethi, AK, Stiefel, U, Cadnum, JL, Donskey, CJ. Occurrence of skin and environmental contamination with Methicillin-resistant Staphylococcus aureus before results of polymerase chain reaction at hospital admission become available. Infect Control Hosp Epidemiol. 2010;31:607-612.CrossRefGoogle ScholarPubMed
12.Pape, J, Waldin, J, Nachamkin, J. Use of BBL CHROMagar MRSA medium for identification of Methicillin-resistant Staphylococcus aureus directly from blood cultures. J Clin Microbiol. 2006;44(7):2575-2576.CrossRefGoogle ScholarPubMed
13.Flayhart, D, Hindler, J, Bruckner, D, et al. Multicenter evaluation of BBL CHROMagar MRSA medium for direct detection of Methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. J Clin Microbiol. 2005;43(11):5536-5540.CrossRefGoogle ScholarPubMed
14.Brown, DFJ, Edwards, DI, Hawkey, PM, Morrison, D, Ridgway, GL, Towner, KJ, Wren, MWD. Guidelines for the laboratory diagnosis and susceptibility testing of Methicillin-resistant Staphylococcus aureus (MRSA). J Antimicrob Chemother. 2005;56:1000-1018.CrossRefGoogle ScholarPubMed
15.Porwollik, S, Frye, J, Florea, LD, Blackmer, F, McClelland, M. A non-redundant microarray of genes for two related bacteria. Nucleic Acids Res. 2003;31(7):1869-1876.CrossRefGoogle ScholarPubMed
16.Frye, JG, Porwollic, S, Blackmer, F, Cheng, P, McClelland, M. Host gene expression changes and DNA amplification during temperature phage induction. J Bacteriol. 2005;187(4):1485-1495.CrossRefGoogle Scholar
17.Tormo, MA, Marti, M, Valle, J, et al. SarA is an essential positive regulator of Staphylococcus epidermidis biofilm development. J Bacteriol. 2005;187(7):2348-2356.CrossRefGoogle ScholarPubMed
18.Koren, O, Rosenberg, E. Bacteria associated with mucus and tissues of the coral Oculina Patagonica in summer and winter. Appl Environ Microbiol. 2006;72(8):5254-5259.CrossRefGoogle ScholarPubMed
19.Frye, JG, Jesse, T, Long, F, et al. DNA microarray detection of antimicrobial resistance genes in diverse bacteria. Int J of Antimicrob Agents. 2006;27(2):138-151.CrossRefGoogle ScholarPubMed
20.Wielders, CLC, Fluit, AC, Brisse, S, Verhoef, J, Schmitz, FJ. MecA gene is widely disseminated in Staphylococcus aureus population. J Clin Microbiol. 2002;40(11):3970-3975.CrossRefGoogle ScholarPubMed
21.Patrick, M, Burns, L. The role of isolation and contact precautions in the elimination of transmission of MRSA. Presented at APIC 2007. http://www.apic.org/Content/…/Education/…/070221_patrick_burns.pdf. Accessed June 9, 2010.Google Scholar
22.Eveillard, M, Martin, Y, Hidri, N, Boussougant, Y, Joly-Guillou, ML. Carriage of Methicillin- resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households. Infect Control Hosp Epidemiol. 2004;25:114-120.CrossRefGoogle ScholarPubMed
23.Suffoletto, BP, Cannon, EH, Ilkhanipour, K, Yealy, DM. Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel. Ann Emerg Med. 2008;52(5):529-533.CrossRefGoogle ScholarPubMed
24.Noda, N, Brown, B, Christ, P, et al. Task Force of the Greater Omaha Area Chapter of the Association for Professionals in Infection Control and Epidemiology, Inc. Guidelines for the control of MRSA. MRSA http://www.goapic.org/MRSA.htm. Published 1993. Accessed March 11, 2010.Google Scholar
25.Scarsi, KK. Should healthcare workers colonized with MRSA avoid patients? http://www.medscape.com/viewarticle/703473. Published 2009. Accessed January 18, 2009.Google Scholar
26.Honda, H, Krauss, M, Coopersmith, CM, et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does Methicillin-resistance matter? Infect Control Hosp Epidemiol. 2010;31:584-591.CrossRefGoogle ScholarPubMed
27.Safdar, N, Bradley, EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008;121(4):310-315.CrossRefGoogle ScholarPubMed
28.Harbarth, S. Control of endemic Methicillin-resistance Staphylococcus aureus: recent advances and future challenges. Clin Microbiol Infect. 2006;12(12):1154-1162.CrossRefGoogle ScholarPubMed
29.Alves, DW, Bissell, RA. Bacterial pathogens in ambulances: results of the unannounced sample collection. Prehosp Emerg Care. 2008;12(2):218-228.CrossRefGoogle ScholarPubMed
30.Mencl, F, Birkle, M, Blanda, M, Gerson, LW. EMTs’ knowledge regarding transmission of infectious diseases. Prehosp Emerg Care. 2000;4(1):57-61.CrossRefGoogle Scholar
31.Roline, CE, Crumpecker, C, Dunn, TM. Can Methicillin-resistance Staphylococcus aureus be found in an ambulance fleet? Prehosp Emerg Care. 2007;11(2):241-244.CrossRefGoogle Scholar
32.Simons, H, Alcabes, P. A model for surveillance of Methicillin resistance Staphylococcus aureus. Public Health Rep. 2008;123:21-29.CrossRefGoogle Scholar
33.Kowalski, TJ, Berbari, EF, Osmon, DR. Epidemiology, treatment, and prevention of community-acquired Methicillin-resistant Staphylococcus aureus infections. Mayo Clin Proc. 2005;80(9):1201-1207.CrossRefGoogle ScholarPubMed
34.Herman, RA, Kee, VR, Moores, KG, Ross, MB. Etiology and treatment of community-associated Methicillin-resistant Staphylococcus aureus. Am J Health System Pharmacol. 2008;65:219-225.CrossRefGoogle ScholarPubMed
35.Gorwitz, RJ, Jernigan, DB, Powers, JH, Jernigan, JA, and Participants in the CDC Convened Experts’ Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. www.cdc.gov/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf. Published 2006. Accessed April 12, 2010.Google Scholar
36.Lee, B, Bailey, RR, Smith, KJ, et al. Universal Methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: An economic model and analysis. Infect Control Hosp Epidemiol. 2010;31:598-606.CrossRefGoogle ScholarPubMed
37.Shalala, DE. Bioterrorism: how prepared are we? Emerg Infect Dis. 1999;5(4):492-493.CrossRefGoogle ScholarPubMed
38.Weber, JT. Community-associated Methicillin-resistant Staphylococcus aureus. Clin Infecti Dis. 2005;41(S):269-272.CrossRefGoogle ScholarPubMed
39.Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis. 2007;13(12):1840-1846.CrossRefGoogle ScholarPubMed